UP-TO-DATE STRATEGY FOR SURGICAL TREATMENT OF CANCER PATIENTS WITH SEVERE CONCOMITANT CARDIOVASCULAR DISEASES


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Abstract

Introduction. Surgical treatment of cancer patients with severe concomitant cardiovascular diseases (CVD) is still a debatable issue. Materials and methods. The study involved 170 cancer patients who had surgical operations. Most patients had coronary heart disease (CHD) as severe concomitant cardiovascular disease -133 cases (78.2%). Simultaneous surgeries were performed in 32 (18.8%) patients; step-by-step tactics was achieved in 138 (81.2%) patients. The study evaluated frequency of complications and mortality. Prophylactic efficiency of surgery for severe concomitant CVDs was determined, as well. The causes of deaths within long-term periods were analyzed, and 3- and 5-year survival was calculated by Kaplan-Meier method. Results. Frequency of complications and mortality in radically operated cancer patients accounted for 55.3% and 4.1%, respectively. A higher rate of complications was registered after simultaneous operations as compared with that after step-by-step tactics - 60% and 52.6% , respectively (р>0.05). Prophylactic efficiency of surgery for severe concomitant CVDs in total accounted for 92.4%. The most effective method for prophylactic myocardial revascularization was coronary bypass (CB) performed at the first step. The main cause of death of radically operated patients in the long-term period was tumor process progression - 31.7%, while CVDs caused much less deaths - 9.8% (р =0,001). 3 and 5-year survival accounted for 59% and 46%, respectively. Conclusions: Surgical treatment of severe concomitant CVDs of cancer patients is a highly effective method for prevention of severe cardiovascular complications. Step-by-step tactics is associated with less frequency of complications. Simultaneous surgery with minimal risk may be performed in a selected group of patient. In the long-term follow up period the main factors, which affected 3- and 5-year survival were the radical type of surgery and the advanced cancer process.

About the authors

Sergei S. Gerasimov

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia

Email: s_gerasimov@list.ru
MD, PhD, DSc, senior researcher, thoracic surgical department, thoracic abdominal division of N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia, 115478, Moscow, Russian Federation 115478, Moscow, Russian Federation

M. I Davydov

MEDCI

125284, Moscow, Russian Federation

M. M Davydov

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia

115478, Moscow, Russian Federation

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